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People’s Health Movement – South Africa Chairperson’s 2013 Report.

Introduction

The context of health and ill health in 2013 has remained intensely divided and unequal. These problems have been highlighted in specific parts of the Eastern Cape where the state of health has been declared a crisis by local organisations and communities. Despite political promises of a new health system, we are still awaiting the government White policy paper on NHI which was due in January 2012. Pilot sites of the NHI have made very little progress in terms of improving health outcomes and in some areas, there is even a documented deterioration of services. The social determinants of health remain a driver of ill health with little progress with regards to nutrition, housing, occupational health or child health. In this context, we are continually inspired to in our work to build a movement of activists who are principled, motivated and well informed in the campaign for the genuine realisation of the right to health.
In 2013 we have started to develop more defined and regular organisational form with regular public and internal meetings, core campaigns and have ended the year with a very inspiring first South African People’s Health University.

REPORT OUTLINE:
1. Regular Planned Events:
a) Public health forums
b) Members meetings
2. National Development
a) Eastern Cape
b) Gauteng
c) Other provinces
3. Campaigns
a) For a People’s NHI
b) Community Health Empowerment
4. PHM SA Networks and Related Events
a) NEHAWU
b) Go 4 Health
c) PHASA
d) Eastern Cape Health Crisis Action Committee
e) UCT Students
f) South African Civil Society Information Services
5. Update on PHM Global
6. Membership
7. Administrative Development
8. Funding
9. SAPHU

1. Regular Planned Events
A key development in PHM SA in 2013 has been the development of a regular meeting format and rhythm. This has taken place against the background of our ongoing campaign work. The SC has met monthly with phone in’s from Gauteng and the Eastern Cape where possible. There have been bimonthly Public Health Forums and member’s meetings.

a) Public Health Forums
In order to have a real impact in shaping health policy in South Africa, PHM-SA identified the need to bring together communities, activists and academics on a bi-monthly basis to discuss current health issues.
After the first public health forum at the end on 2012 on Unhealthy Mining, we have hosted 4 Public Health Forum debates. These have been:
Unhealthy Farming March 2013
Partnered with Women on Farms, this meeting discussed the health issues for farm workers and the specific health and trauma issues experienced during the 2012/13 Farmworkers Strike. This well attended and vibrant meeting set the backdrop for further work in the area. Specifically Ayesha Aziz a visiting PhD student, volunteered on behalf of PHMSA, to conduct interviews in communities affected by poor access to health care during the strike. This report highlighted the complex political issues regarding access to health facilities during the farm workers strike where the separation between health services and law enforcement agencies was unclear. Fear of arrest resulted many injured workers not seeking the medical attention they needed. This report was been sent to the Western Cape Department of Health and published in the Mail and Guardian weekly newspaper.
Community Care Workers Public Forum May 2013
This meeting was held in partnership with Wellness Foundation and the Community Care Worker’s Forum. It was an excellent meeting where the plight and super exploitation of care workers as well as the tremendous work that they do was highlighted. As PHM SA we believe that a People’s NHI is not possible without the proper and formal recognition of CCW and the establishment of decent working conditions. A joint press release was written by the three organisations and posted on websites and various other electronic media. We hope to continue to build this initiative into a core campaign of PHMSA.
Housing Public Forum – July 2013
After housing continued to be raised at all PHMSA meetings as a major cause of ill health, we decided to call a Public Health Forum on Housing. The meeting was held in Khayelitsha in partnership with the Housing Assembly, a movement of individuals and organisations campaigning for decent housing. Despite the terrible weather conditions on the day, the meeting was very well attended by both local residents and many from far flung areas. We heard first hand stories of the terrible conditions of damp, poor insulation and unsafe construction many families are faced with. Also, the struggles for access to land and decent new housing were highlighted. The meeting took place in the context of the annual flooding problems experienced in Cape Town in poor areas every year, so the descriptions were particularly poignant. The Public Forum was attended by representatives from the City of Cape Town and City Health. One of the outcomes was for community members to take pictures of the flooding of their homes and other housing problems for posting on the PHM SA website.

 Health Committees Public Forum – September 2013
This meeting was held in partnership with the Learning Network at UCT and the Metro Community Health Forum. It happened in conjunction with a presentation of Photo journalism organised by the Learning Network. In this photo exhibition, communities documented key causes of ill health in their communities such as stagnant water, pollution, drug abuse and unsafe play areas. The meeting was attended by over 200 people with a good representation of different communities. The problem with community representation in health committees and the absence of formal legislation governing the function and powers of these committees was highlighted. The outcome was an overwhelming call for proper and democratic community representation in the health system and proper consultation in the process of drafting legislation.

b) Members Meetings
In the first quarter of 2013 PHM-SA undertook an exercise to consolidate our membership databases and meetings registers in preparation for a membership drive and to enhance our communication between members. A key part of this was to launch bi-monthly member’s meetings.
Five PHM-SA member’s meetings were held during this year. This new development marked the beginning of the transformation of PHMSA from a small group mainly linked to the steering committee, to a truly membership based organisation. The members meetings were vibrant and spirited always leaving us feeling inspired by the tremendous work being done by so many and the need to consolidate and co-ordinate that work. While there were always new members at the meetings, there is also a growing core of regular attendees who we hope will form the basis of new leadership in PHMSA.
We believe that by hosting these bi-monthly meetings PHM-SA will be able to expand our membership base and to convert passive members into active ones and develop a set of committed activists to contribute to PHM-SA.

2. National Development
a) Eastern Cape Province (Thanks to Lulamile for this part of the report)
There has been significant and exceptional growth of PHM SA in the Eastern Cape in 2013. This began with a planning meeting in June which was part of an integrated workshop with Go4Health Campaign was held in Lusikisiki. PHM SA in the province was then launched in Port St John’s immediately afterwards.

PHM aims to strengthen agency of people in communities, especially working with children and around health while it promotes on-going campaigns at community level. It was then PHM has decided to extend to rural areas and the OR Tambo District in the Eastern Cape was identified and agreed upon as one of the areas because it was one of NHI piloted district and its where one of the PHM Steering Committee is based. This was a good way of creating a space for dialogue while PHM continues to develop and strengthen partnerships, strengthen existing campaigns of partners and PHM. Sustainability in each community would be through the organisations and community members in Eastern Cape where PHM is going to act as a catalyst and to give support and participate through individuals and partner organisations. Lusikisiki and Port St Johns were targeted as the entry in OR Tambo municipality. Both areas have the same experience when it comes to poor access to health care and are both in deep rural areas of the Eastern Cape.

Both these meetings were successful with various organisations, traditional leaders, human rights organisations, FBOs and Traditional leaders coming forward as part of the People’s Health Movement showing a need for urgent action in addressing health challenges and other social determinants of health in the Eastern Cape Province, OR Tambo District.

The problems in the Eastern Cape include: dire poverty and unemployment; childhood malnutrition and infectious disease; HIV and TB; poor transport preventing access to health facilities; poorly staffed and equip health facilities; a significant number of child headed households; non payment and underpayment of healthworkers.

Village and Guje clinics have been reported to be the worst health facilities in OR Tambo in provision poor health care services. Despite its challenges, there is nothing that has improved in making these facilities better.

Key success and key campaigns of the PHMSA-EC.
Membership
Since PHMSA-EC started in June 2013, membership has increased significantly. Ngqeleni has remain a leading area, followed by Mthatha, Lusikisiki, Port St Johns and Libode. About half of the PHMSA-EC members have adopted People Right to Health Charter. An audit about this will be verified by PHMSA national organisor.
Circle member meetings
Circle member meetings has sat five times, since PHMSA-EC started in the EC. Continuous other Cycle member meetings continued to take place. These includes:-
a) 19th Eastern Cape Interim Committee held in Libode, DELTA offices
b) 22nd July 2013 circle member meeting held in Port St Johns, Presbyterian Church Hall
c) 8th August 2013 circle member meeting held in Port St Johns, Presbyterian Church Hall
d) 6th September 2013 meeting held in Lusikisiki, Paralegal Centre Board Room
e) 29th October 2013 cycle member meeting held in Mthatha, Emmanuel Conference Room

Common issues arise in these meetings were around children’s campaign, Health crisis coalition, National Health Insurance, Access to treatment and Community Care Workers Campaigns.
In these meetings, about 15 constant organisations were actively involved and others were coming and going. These includes PSJ Creative Young Women Group, Social Change, Edabini-bafazi, Masithandazisane, Lusikisiki Legal Advice Centre, TAC, Masibumbane Development Organisation, Catholic Development Centre, Sinakho, DELTA, Council of Churches, Paralegal, Siyakhathala, Nompilo HCBC, Child Welfare and Phumlani
ECHCAC – Bisho March
In support of crisis in health coalition in the Eastern Cape, PHMSA has sent 15 delegates to Bisho on the 13 September 2013. Since then, PHMSA has been part of various meetings of the ECHCAC.
People’s NHI workshop
In capacitating its members, PHMSA has conducted two, two day workshops on NHI and Primary Health Care to its members. These workshops were a great success.
Walter Sisulu University
PHMSA was introduced formally at Walter Sisulu University. Lecturers, students, Head of Department has welcomed the presents of PHMSA-EC in the university and since then, 32 people has joined PHM.

 PHMSA-EC adopted Campaigns

In a recent plenary meeting held in Mthatha workshop, the circle member’s meeting has adopted 4 campaigns. In each campaign, 2 organisations were given a mandate to coordinate each campaign. This includes sharing and allocation of limited resources by member organisations.

Children’s Right Campaigns
This campaigns aimed in ensuring that the rights for all children are protected. The adoption of this campaign follows series of events on children’s vulnerability in various forms of abuse. PHMSA-EC have seen the necessity to take this campaign seriously and at this stage, two families have been rescued and children have access to equal rights and opportunities.

Access To Treatment Campaign
The meeting felt that there is a necessity to form partnership with various other organisations that deal about access to treatment. TAC and NAPWA has to be recruited as well in participating in this campaign even though they deal with selective health. There was also a call and a need to strengthen availability of mobile clinics in deep rural areas.

c) Gauteng Circle
A number of Gauteng members are part of the steering committee however it has been difficult to hold regular face to face meetings due to their cost. Instead, we have tried to keep contact telephonically. The Gauteng PHM SA circle planned and hosted a large official launch in October this year attended by over 200 grassroots activists. Among them were many community representatives and health committee members. The circle elected its own steering committee at this meeting which is a great step towards consolidating and building on the work in this important province.

3. Campaigns
a) Campaign for a People’s NHI
On the 21 February, the PHM-SA hosted the Coalition for a People’s NHI to develop a strategy for consolidating a progressive response to the NHI policy developments. The aim of the meeting was to update partners on the current status of the NHI policy process and implementation of the NHI pilot sites; to list the opportunities and threats the current NHI proposal offers for the achievement of progressive health system transformation; identify key themes for what a progressive NHI policy proposal should contain by identifying the principles of a people centred health system and finally to develop an NHI campaign plan.

The meetings was attended by numerous organisations including Section 27, TAC, Soul City and many others. The key outcomes of the meeting were that there continues to be much confusion about the NHI and little known about the status of the pilot districts. The Coalition agreed to adopt Ten Principles for a People’s Health System:

1. Right to Health
2. Single, Publicly Funded and Administered Health System
3. Free at Point of Service
4. Progressive Taxation
5. No Profit Making in Health Care Provision
6. Primary Health Care.
7. People’s NHI that Addresses the Social Determinants of Health
8. Quality Care in the Health System
9. People’s Participation and Empowerment
10. People’s NHI which Emphasises Rural Health Development

A media article was written by PHM-SA in response to criticisms of the plans for universal coverage being developed by government. This article was published the Mail and Guardian and generated an important debate around the issues.

b) Community Health Empowerment Campaign
This campaign is aimed at developing community knowledge about social determinants of health, primary health care and health systems. Part of this is support of health committees and enabling communities to support and hold to account local health facilities. The campaign has been piloted in the Sea Winds area of Lavender Hill and impoverished township in Cape Town. Four community meetings have been held with PHM-SA facilitating the discussion around local community health issues and health clinic problems. The community group is in the process of setting up a health action committee to take this work forward.

4. PHM SA Networks
Nehawu – nurses forum training/congress
PHM-SA has developed an important partnership with NEHAWU one of the largest and most influential public sector unions in the country. NEHAWU has requested health systems training for its shop steward leadership. A two day training meeting was health with the NEHAWU nurses forum in Johannesburg in July 2013. There is an expressed interest in expanding on this educational workshop to include broader aspects of health systems training over a longer period of time. This resulted in the strong representation and involvement of NEHAWU in the SAPHU.
Go4Health Project
PHM-SA partnered with the Eastern Cape NGO Coalition to implement the Go4Health project in OR Tambo health district of the Eastern Cape. The purpose of GO4Health was to determine the local social determinants of health, local health problems with hospitals and clinics and use these findings to develop a bottom up approach to defining global health goals. The campaign was a tremendous success with a number of meetings with participants. While the work was mainly investigative, it has generated keen interest in organising around health. PHM-SA hopes to help facilitate report back meetings and assist in developing the broader campaign for the right to health in the area.
Public Health Association South Africa
PHMSA ran a workshop about NHI at this conference. It was very well attended and there was a vigorous discussion about involvement of students and communities in PHM
UCT Students Meeting – The Broader Picture in October
This very well attended medical students meeting introduced the concepts of social determinants of health to young health workers by using the narrative of a malnourished child. There was an interesting and lively discussion which inspired many students to look beyond the physical aspetcs of health and examine the root causes of illness.
South African Civil Society Information Services
Two PHM SA steering committee members were asked to give keynote inputs at this very importand panel discussion on NHI. The event was covered by the media both formal and social and had a great impact on profiling PHM SA’s position on NHI.
FOS meeting in Mozambique
FOS the organisation which is the primary funder for PHM SA, has a number of partners in the Southern African region including Mozanbique, Namibia and Zimbabwe. PHM SA attended the annual partners meeting which focussed on issues facing trade unions and alternative ways of organising.

5. PHM Global (Thanks to Bridget Lloyd and Anneleen for this report.)
PHM SA forms part of the Global People’s Health Movement from which we continuously draw strength and inspiration. PHM globally currently has a presence in over 70 countries in the world. PHM SA is fortunate to have part of the Global secretariat in South Africa at the moment and one of our steering committee members, David Sanders, is an active member in both the Global and South African Steering Committees providing an crucial link between local and global campaigns.
Below are a few highlights of the work taking place at the international level.

Post 2015 development agenda:
• Facilitated consultations on the post 2015 development agenda with a focus on South and South East Asia. Nine PHM country circles submitted country reports which, together with the dialogue during a consultation attended by over 80 participants from more than 20 countries lead to the development of a report submitted to WHO. The consultation took place as a side event at the Prince Mahidol Award Conference 2013 on 29 January in Bangkok. The report submitted can be found on the PHM website
PHM position papers:
• We have started developing position papers on a number of areas of interest. The first was the Framework Convention on Global Health. A number of other position papers are being developed on: Community Health Workers, Primary Health Care; Universal Health Coverage and a number of others.
Programmes:
WHO Watch:
• Watching activities took place in Geneva in January 2013 and May 2013. In addition regional watching activities were initiated this year and included AFRO, PAHO and SEARO.
GHW4:
• GHW4 will be out in 2014! Chapters are currently being written and / or edited.
IPHU:
• There have been IPHU in LA, California; Thessaloniki, Greece; and of course in South Africa. We also facilitated the second online International People’s Health University.
Health for All campaign:
• The past year we have been preparing for the PHM Health for All Campaign which works towards the achievement of Health for All as envisioned in the Alma Ata Declaration through uniting civil society globally to mobilise for political, social and economic transformations.
Other news:
LA Health Assembly
• During the week from 7 to 12 October 2013 in Cuenca, Ecuador, members of People’s health Movement Latin America had the opportunity to reunite again to debate and exchange experiences and ideas about how to defend the right to health. A whole week long there were different testimonies, reunions and ceremonies. There were several moments in which the participants got deeply motivated to take action. Many presentations dealt with the protection of Mother Earth against the megaprojects and gave examples of protests against killer corporations and the hegemonic capitalist economic model that is preying on life.

PHM East Africa Regional Meeting:

  • PHM activists from Djiboutie, Rwanda, Kenya, Burundi, Tanzania and Uganda have gathered in Kampala (Uganda) from 28 October to 30th of October. Their objective is to strategise and plan for a stronger people’s movement for Health for All locally in their countries as well regionally. How to engage with Health for All – The Campaign, planning for advocacy and mobilisation and how to link struggles at regional level are only few of the agenda items.

Attendance at global events

  • World Social Forum: The People’s Health Movement (PHM) and Oxfam-France call for actions towards democratizing global health governance, realizing equitable and universal health care systems, and addressing social determinants of health. During the WSF 2013, the PHM jointly with Oxfam-France organised three workshops.
  • Third Global forum on Human Resources for Health: together with other civil society organizations, PHM developed a statement: Health workers and a robust health system are essential for universal health coverage (UHC), and realizing the right to health through universal health systems.
  • Alter Summit: On June 7th and 8th, representatives of PHM Europe took part in the Alter Summit, an international gathering of activists and leaders of social movements and trade unions that took place in Athens, Greece. Aim of the event was to create a convergence of the local, national and European struggles to end austerity and claim a true democracy.
  • Activists from the PHM met during the WHO 8th Global Conference on Health Promotion to critique the official Conference Statement and develop a progressive call for action based on strong social justice principles. The draft statement reflects our deliberation and is being circulated for further comment and debate. Please send comments through using this web form by the 28th of June 2013. We wish to support the progress on Health Promotion and Health in All Policies and call for actions toward health for all.

6. PHMSA Membership
PHM-SA membership has grown significantly in 2013. Many of our members have specific areas of interest and become involved in campaign areas related to these. The aim in 2013 was to redefine membership into activist and associate members. Also, PHM-SA aims to broaden the decision making around strategy and vision for the organisation. The membership has been consolidated into a single user friendly database. The five members meetings have begun this work and have helped us identify members for whom we should prioritise health systems training and who have potential and eagerness to fill leadership positions in the organisation. There is a growing circle of students at both the University of Cape Town and University of Stellenbosch who are involved in PHM-SA and there has been a steady increase in membership and attendance at all PHM-SA meetings.

7. Administration
One of our objectives in 2013 was to develop and effective membership database and sms list. This has largely been achieved and we are slowly moving over from previous outdated lists. To date we have piloted the sms invitations and communications with great success and as a result have reached a broader range of activists.
Thoko, our organisor who joined us toward the end of 2012 left in August 2013, to join a sister organisation in struggle, BEMF (Budget Expenditure Monitoring Forum). She remains on the steering committee and is very active in PHM SA.
Tinashe has taken over the role of administrator and organisor. His work has been at many levels, including continuing the development of effective office systems, finalising the changes to the website, organising the public forums, managing the finances and helping to organise the first SAPHU.
Many of our systems still require ongoing work. One of the problems is the need to get the house in order and also keep moving and responding to the urgent health matters of the day.

8. Funding
We have a three year agreement with FOS for funding for 2014 – 2016. This long period of guaranteed and stable funding is a major step forward for the organisation. However, we do need more resources than this to complete our growing list of campaigns and activities, particularly the expansion of the Eastern Cape circle as well as the SAPHU.
We received extra funding from FOS for SAPHU and an additional support from Oxfam-Australia. We hope to continue to fundraise for next year’s SAPHU.

9. South African People’s Health University
So finally, SAPHU… The latter part of 2013 was consumed with the organisation of the first SAPHU. It was an ambitious project with a shoestring budget and very little time. Many PHM SA members worked tirelessly for many hours and days to make the SAPHU a success. The 5 day activist school as attended by 45 delegates, with 21 delegates from NEHAWU. All parts of the country were represented with delegates from various parts of the health field. It was a tremendous success both in terms of learning for us all and also in terms of sharing ideas, experiences and building greater solidarity across provinces, organisations and levels of the health system. We hope this will become a regular event and grow from strength to strength.

Conclusion
PHM SA is small but growing. We have the potential to have a tremendous impact on the health politics of the day. Importantly, we have a duty to have that impact at a time when the possibility of real change in the health system may be just within our reach. PHM SA has the potential to occupy a unique position within the progressive health sphere. This is because we have an unusual combination of academic knowledge and activist experience, coupled with a clear political programme for transformation in health and the growing ability to train layers of people in this knowledge. Our urgent need however, is to build up a new layer of leadership who can extend the work we do beyond our current influence and we need to build a strong membership base to develop a genuine people’s movement.
For 2014, I believe we should continue the Public Health Forums with the rich debate and cross pollination of ideas they bring, we should strengthen and build our members meetings, rotating them through different areas, I believe we should focus on three campaigns: People’s NHI; Community Care Workers and Community Health Empowerment. We need to build on the tremendous momentum currently present in the Eastern Cape and capacitate Gauteng circles in the same way. Perhaps in 2014, we can look at KZN as the next province to extend to. Finally, we should host another SAPHU and hopefully a National Health Assembly at the end of 2014.
May we grow from strength to strength, may we find new energy and new people for our work, may we tirelessly fight for the right to health for all and may we do all of this with the kind of care, compassion and respect we wish to given to all in the health system in South Africa.

For any futher information feel free to contact  us on 021 447 5770 email southafrica.phm@gmail.com

About Tinashe Njanji